Non-Hodgkin's B-cell lymphoma of the ovary: A case report and review of the literature

Unusual Presence of Synchronous Primary Ovarian and Thyroid Extranodal Non-Hodgkin Lymphoma Without Lymph Node Involvement

ABSTRACT

Extranodal lymphomas without lymph node involvement are rarely observed and create diagnostic challenges. We present the case of a 33-year-old woman who was admitted with abdominal swelling. Ultrasonography findings suggested bilateral ovarian masses. 18 F-FDG PET/CT revealed intense uptake on the bilateral pelvic mass and thyroid gland. Following excisional surgery and thyroid fine-needle aspiration biopsy, the patient was diagnosed with diffuse large B-cell lymphoma. This case is exceptionally rare, as it presents 2 synchronous extranodal involvements in the ovaries and the thyroid gland independently while not presenting any lymph node activity, which has not been reported before.

Imaging of ovarian lymphoma

OBJECTIVE

The aim of the study is to describe the radiological spectrum of appearances of ovarian lymphoma (OL). The manuscript describes the radiological aspects of OL to assist the radiologist in achieving correct orientation of the diagnosis.

METHODS

We conducted a retrospective evaluation of imaging studies of 98 cases of non-Hodgkin's lymphoma, with extra-nodal localisation (ovaries) in three cases (1 primary, 2 secondary). A literature review was also performed.

RESULTS

Of the three evaluated women, one had a primary ovarian involvement and two had a secondary ovarian involvement. The most common lesion characteristics were a well-defined, solid homogeneous and hypoechoic mass at US. CT depicts OL as a well-defined, non-infiltrating, homogeneous hypodense solid mass, with mild contrast enhancement. On T1-weight MRI, OL appears as a homogeneous mass of low signal intensity, which enhances avidly following intravenous gadolinium.

CONCLUSION

Clinical and serological presentation of OL can be similar to that of primary ovarian cancer. As imaging plays a central role in the diagnosis of OL, the radiologist should be familiar with US, CT and MRI appearances of this condition to correctly orient the diagnosis and so avoid unnecessary adnexectomy.

Primary ovarian lymphoma: A case report

While Non-Hodgkin Lymphoma (NHL) often involves the ovaries at time of autopsy, it is rarely present at the time of diagnosis. Here we present a case of a 20-year-old who presented with a large adnexal mass and elevated B-HCG, CA-125, and LDH. The patient underwent exploratory laparotomy, and frozen section of the left ovarian mass was suspected to be a dysgerminoma. Final pathologic diagnosis was Ann Arbor stage IVE Diffuse Large B-Cell Lymphoma, germinal center subtype. Patient is currently undergoing chemotherapy and has received the 3 of a planned 6 cycles of R-CHOP.

An Extranodal Site of Diffuse Large B-cell Lymphoma Presenting as Ovarian Cancer

Due to its uncommon nature, primary ovarian lymphoma has no clinical particularities and can be confused with other ovarian cancers. It poses a twofold diagnostic and therapeutic challenge. An anatomopathological and immunohistochemical study is the crucial step in the diagnosis. Our case was a 55-year-old woman diagnosed with an Ann Arbor stage II E ovarian non-Hodgkin's lymphoma who initially presented with a painful pelvic mass. This case reflects the major role of an immunohistochemical study in the diagnosis workup, leading to the appropriate management of such rare tumors.